Peri-mitral atrial flutter in patients with atrial fibrillation ablation

Matsuo, Seiichiro; Wright, Matthew; Knecht, Sébastien; Nault, Isabelle; Lellouche, Nicolas; Lim, Kang-Teng; Arantes, Leonardo; O'Neill, Mark D.; Hocini, Mélèze; Jaïs, Pierre; Haïssaguerre, Michel

doi:10.1016/j.hrthm.2009.09.067

Cited by 153Cardiac Arrhythmias and TreatmentsAtrial Fibrillation Management and OutcomesCardiac electrophysiology and arrhythmias

Peri-mitral atrial flutter in patients with atrial fibrillation ablation

Matsuo, Seiichiro, Wright, Matthew, Knecht, Sébastien, Nault, Isabelle, Lellouche, Nicolas, Lim, Kang-Teng, Arantes, Leonardo, O'Neill, Mark D. +3 more·2010·Heart Rhythm

DOI 10.1016/j.hrthm.2009.09.067

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Abstract

Background Peri-mitral atrial flutter (PMFL) is commonly encountered in patients undergoing atrial fibrillation (AF) ablation.Objective The purpose of this study was to determine the electrophysiologic characteristics, procedural success, and medium-term outcomes in patients with PMFL.Methods The study consisted of 50 consecutive patients (45 men and 5 women, age 57 +/- 12 years) with PMFL following or during AF ablation. Of the 50 PMFLs, 24 occurred during AF ablation (16 at index ablation and 8 at repeat procedure for recurrent AF), and 26 developed during follow-up. Ablation of PMFL was performed by creating a linear lesion joining the mitral annulus to the left inferior pulmonary vein.Results The incidence of PMFL was higher in patients with mitral isthmus (MI) ablation performed during AF ablation, prior to the development of PMFL, than in those in whom MI ablation was not performed (23% vs 8%, P = .04). Following the procedure, PMFL was more frequent in patients with prior MI ablation than in those without (41% vs 15%, P <.01). Seventy percent (35/50) were terminated by ablation with 6.4 +/- 6.9 minutes of radiofrequency application. Among patients in whom PMFL terminated, supplemental ablation was required for bidirectional conduction block in 66% (23/35). MI block was achieved in 92% (46/50) using 13.6 +/- 7.4 minutes of ablation. At mean follow-up of 19 +/- 4 months, 96% of patients were free from PMFL.Conclusion PMFL can be terminated by MI ablation, but the procedure is proarrhythmic. Supplemental ablation is necessary to establish bidirectional block of the line despite termination of PMFL in the majority of patients.

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Ablation of atypical atrial flutter/macroreentrant tachycardia is more challenging and has a lower success rate and higher recurrence rate than cavotricuspid isthmus ablation.
“Atypical AFL/MRT ablation can be very challenging and has a lower success rate and a higher recurrence rate than CTI ablation.163,164,204 -206”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [164]

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Authors: Matsuo, S., Wright, M., Knecht, S., Nault, I., Lellouche, N., Lim, K.-T., Arantes, L., O'Neill, M. D., Hocini, M., Jaïs, P., & Haïssaguerre, M.
Affiliations: Hôpital Cardiologique du Haut-Lévêque (FR)
King's College London (GB)
ORCID: Matsuo, Seiichiro
Wright, Matthew
Knecht, Sébastien
Nault, Isabelle
Lellouche, Nicolas
O'Neill, Mark D.
Hocini, Mélèze
Venue: Heart Rhythm
Publisher: Elsevier BV
Published: 2010-01
Volume: 7
Issue: 1
Pages: 2-8
ISSN: 1547-5271 (ISSN-L)
DOI: 10.1016/j.hrthm.2009.09.067
OpenAlex: W2029818197
Cited by: 153
References: 27
Citations by year: 2026: 1 · 2025: 4 · 2024: 7 · 2023: 3 · 2022: 6 · 2021: 10 · 2020: 5 · 2019: 6 · 2018: 6 · 2017: 19 · 2016: 8 · 2015: 9 · 2014: 9 · 2013: 10 · 2012: 20
FWCI: 10.69
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Heart Rhythm (publishedVersion)
PubMed (publishedVersion)
Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
Research Portal (King's College London) (submittedVersion)
Funders: King's College London
Department of Health and Social Care
King's College Hospital NHS Foundation Trust
National Institute for Health Research
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords: atrial fibrillation ablation, mitral isthmus ablation, drug-induced arrhythmia, bidirectional block, radiofrequency catheter ablation, atrial fibrillation recurrence, mitral annulus, left inferior pulmonary vein
MeSH terms: Atrial Fibrillation, Atrial Flutter, Female, France, Humans, Male, Middle Aged, Mitral Valve, Prospective Studies, Pulmonary Veins, Reoperation, Risk Factors, Incidence, Catheter Ablation, Electrophysiologic Techniques, Cardiac

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Peri-mitral atrial flutter in patients with atrial fibrillation ablation

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